Paraplegia physical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Abhishek Singh, B.P.T [2]

Overview

Paraplegia denotes a state of paresis or paralysis of both lower limb due to psychogenic cause or interruption in any part of motor path from the cerebral cortex to & including the muscles.Often internal organs below the waist are involved.

Physical therapy

Phases Of Rehabilitation

• Phase1: Immediately after spinal cord injury(SCI),there is loss of movement & function due to neurotrauma & immobilization .The main emphasis of rehabilitation is to lessen adverse effects of immobilization.It includes all therapeutic intervention during the critical & acute care stages of rehabilitation.It may lasts from a few days to several weeks,when the patient begin activities out of bed.Goal- prevention of secondary complications.
• Phase2:Early rehabilitation phase.Out of bed activities are tolerated for a longer duration & patient begins to work toward specific long term goals & able to participate in therapeutic programs for minimum of 3 hours per day.
• Phase3:Most active & rewarding period,efforts of weeks & months of work are realized & results can be seen.The patient gains varying level of independence in specific skills.The patient may be taught advance skills in transferring,wheel chair mobility,grooming & various Activities of daily living(ADL).
• Phase4:Aimed at a smooth transition to home,patient discharged from rehabilitation centre at this stage.
• Phase5:Comprises of outpatient & other follow-up services,as well as community reintegration.Individuals may return to work.

Positioning

• Postural Re-education:Two pillows are generally sufficient to extend(to maintain hyper extension of spine) and support fractures of dorsolumbar spine.Pillows are adjusted in such a way that bony prominences are always free from pressure.Flexion & rotation of trunk & lower limbs are specifically avoided.
• Upper Limbs Positioning
• Shoulder - slightly flexed;to relieve pressure on shoulder.
• Elbow - extended.
• Forearm - supinated & supported by pillow.
• Upper arm - pillow between arm & chest wall.
• Lower Limb
• Hips- extended & slightly abducted.
• Knees - extended but not hyperextended.
• Ankles - neutral or mild dorsiflexion.
• Toes - extended

One or two pillows are kept between the legs to maintain abduction & prevent pressure on the bony points,i.e. medial condyles & malleoli.

Passive Movements

Passive movements of paralyzed limbs are essential to stimulate circulation ,preserve FROM(full range of motion) in joints & soft tissues & prevent muscle shortening. Treatment starts usually on first day after injury & during this spinal shock period(approx 6 weeks) treatment should be given twice daily. While the patient is immobilized in bed or turning frame,full ROM(range of motion) exercises should be completed slowly,smoothly & rhythmically(to avoid injury to insensitive,unprotected joints & paralysed structures) daily except in those areas that are contraindicated or needs selective stretching for example Motion of trunk& some motion of hip are contraindicated.Generally,straight leg raise more than 60° & hip flexion beyond 90° should be avoided.This will put strain on lower thoracic & lumbar spine. When spinal activities returns limb should be handled very carefully so as not to elicit spasm & reinforce the spastic pattern.Forced PROM(passive range of movement)against spasticity may cause injury or fracture of the limb.